Holmium laser enucleation of the prostate

Holmium laser enucleation of the prostate

Anesthesia type	GA
Airway	LMA vs. ETT
Lines and access	1 PIV
Monitors	Standard ASA monitors
Primary anesthetic considerations
Preoperative
Intraoperative	Keep patient still during lasering and morcellation to avoid inadvertent tissue damage
Postoperative	Prostate bleeding is common
Article quality
Editor rating	Unrated
User likes	0

Holmium laser enucleation of the prostate is a surgical treatment for benign prostatic hypertrophy (BPH).

Overview

Indications

Benign prostatic hypertrophy (BPH)

Surgical procedure

A Holmium laser device is inserted via the urethra to remove prostate tissue.

Preoperative management

Patient evaluation

System	Considerations
Airway
Neurologic
Cardiovascular
Pulmonary
Gastrointestinal
Hematologic
Renal	Postrenal obstruction resulting in hydronephrosis and elevated BUN/Cr from BPH is common
Endocrine
Other

Labs and studies

BUN/Cr can sometimes be elevated if patients have hydronephrosis from BPH.

Patient preparation and premedication

N/A

Regional and neuraxial techniques

The procedure can be done under spinal with moderate sedation if there is contraindication to GA or if strong patient preference. It is very important that the patient does not move during the procedure, so careful patient selection must be performed.

Intraoperative management

Monitoring and access

• Standard ASA monitors
• 1 IV is sufficient

Induction and airway management

LMA or ETT are both options. If there is more prostate tissue to remove, higher risk of bleeding, the surgeons may request ETT with full paralysis.

Positioning

Supine, lithotomy

Maintenance and surgical considerations

Patients need to be kept still to avoid inadvertent lasering of tissue. At the end of the case, the prostate tissue that has collected will be run through a morcellator device, which is inserted at the end. This has the highest chance of causing inadvertent damage if the patient is not kept still.

Postoperative management

Disposition

Typically, PACU and home the same day. Patients can go home with a catheter still in place.

Potential complications

The prostate tissue is very vascular and can result in post-op bleeding. Patients are typically monitored with continuous bladder irrigation (CBI), which can dilute even large amounts of bleeding, causing delay in treatment.

Procedure variants

	Variant 1	Variant 2
Unique considerations
Indications
Position
Surgical time
EBL
Postoperative disposition
Pain management
Potential complications